Using Prior Psoriasis Treatment Failure to Determine Future Treatment Success


Evaluating prior unsuccessful therapies could potentially improve psoriasis treatment.

There are different demographics, clinical characteristics, healthcare-related resource utilization, and costs among patients with psoriasis.

A recent study finds that advanced biological knowledge of psoriasis can lead to the development of biological agents that prevent T cell function and block tumor necrosis factor (TNF)-α, interleukin (IL)-12/IL-23, and IL-17 activities.

Patients have been known to become unresponsive to these biological agents and fail to respond to first-line treatment, or the treatment becomes dangerous due to side effects.

In this retrospective observational cohort study published by Journal of Manager Care & Specialty Pharmacy, researchers evaluated demographic and clinical characteristics of 2 types of patients, as well as assessing healthcare resource utilization and costs.

The first group were patients with psoriasis who have treatment patterns that suggest the failure of a new biologic agent, such as switching or discontinuing biologics, adding nontopical psoriasis medication, and a dose increase over the recommended maintenance dose. These patients are referred to as treatment-regimen failures.

The second group were patients with psoriasis who have no history of treatment failures, referred to as non-treatment-regimen failures.

Researchers collected data from January 2010 to December 2011 from Truven Health Analytics’ MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database.

There were 2146 patients included in the study. Patients were commercially insured or had Medicare supplemental insurance.

Results: Treatment-Regimen Failures

Researchers found that women comprise 53% of the patients who failed their treatment-regimens.

Of all the patients included in the study, 41.5% were treatment-regimen failures, with 22.4% of those patients switching biologic agents.

The average time the patients switched was 173 days and about 49.9% of treatment-regimen failures discontinued therapy altogether.

These patients also had higher incidences of comorbidity, including cerebrovascular disease, myocardial infarction, hypertension, chronic pulmonary disease, depression, and anxiety.

According to the study, treatment-regimen failures also involved more concomitant medications pre- and post-index period.

Results: Non-Treatment Regimen Failures

Researchers found that men comprise 61% of the patients in the non-treatment-regimen failure group.

Non-treatment-regimen failures had fewer outpatient and inpatient visits during the pre- and post-index periods.

Significantly, this group had less psoriasis-related inpatient admissions in the pre-index period. These patients were observed to have lower costs when an outpatient visit was needed.

However, researchers discovered that non-treatment regimen failures involve higher overall costs during the post-index period, though the costs were lower during the pre-index period.

Psoriasis-related healthcare costs were higher in non-treatment-regimen failures during the post-index failures.

Researchers noted that the use of concomitant medications decreased in both groups from pre- to post-index period. This suggests that in some patients, biologics can reduce the use of nonbiologic psoriasis medications, or the use of biologics individually may be inadequate.

With both groups, there was no significant difference in pharmacy costs.

According to the study, failing treatment with biologics may reduce patient satisfaction and be unwilling to try alternative biologics. This could potentially result in greater resource utilization and an increase in costs.

The authors noted there were significant differences in demographic and clinical characteristics, along with healthcare-related resource utilization and costs among the groups.

Understanding the differences between these groups could help the patient, as well as physicians, to better treat psoriasis, the study concluded.

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